TATEK KETEMA TAKELE MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****26

License Status

ACTIVE

Business

Title

First Name

TATEK

Middle

KETEMA

Last Name

TAKELE

Business Name

TATEK KETEMA TAKELE MD

Original Issue Date

10/25/2007

Effective Date

06/05/2023

Expiration Date

07/31/2026

City

ROCKFORD

State

Zip

61104

County

WINNEBAGO

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

06/05/2023